胫骨远端骨折解剖锁定钢板固定的有限元分析

doi:10.3969/j.issn.2095-4344.2017.35.019

中国组织工程研究 ›› 2017, Vol. 21 ›› Issue (35): 5691-5696.doi: 10.3969/j.issn.2095-4344.2017.35.019

• 数字化骨科 digital orthopedics • 上一篇下一篇

胫骨远端骨折解剖锁定钢板固定的有限元分析

王海燕¹，许贵存²，蔡永强¹，李志军¹，张少杰¹，高尚¹，王星¹，李筱贺¹

¹内蒙古医科大学基础医学院人体解剖教研室，内蒙古自治区呼和浩特市 010110；²内蒙古医科大学附属医院急诊外科，内蒙古自治区呼和浩特市 010110

出版日期:2017-12-18 发布日期:2018-01-02
通讯作者: 许贵存，硕士，主任医师，内蒙古医科大学附属医院急诊外科，内蒙古自治区呼和浩特市010110 李筱贺，博士，教授，内蒙古医科大学基础医学院人体解剖教研室，内蒙古自治区呼和浩特市 010110
作者简介:王海燕，女，1975年生，内蒙古自治区通辽市人，蒙古族，2003年内蒙古医科大学毕业，硕士，副教授，硕士生导师，主要从事数字解剖及生物力学研究。
基金资助:
2016年度内蒙古自治区留学人员科技活动项目(2016)；内蒙古科技计划项目(2016)

Finite element analysis of posterior anatomical locking plate for distal tibia

Wang Hai-yan¹, Xu Gui-cun², Cai Yong-qiang¹, Li Zhi-jun¹, Zhang Shao-jie¹, Gao Shang¹, Wang Xing¹, Li Xiao-he¹

¹Department of Anatomy, School of Basic Medicine, Inner Mongolia Medical University, Hohhot 010110, Inner Mongolia Autonomous Region, China; ²Department of Emergency Surgery, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010110, Inner Mongolia Autonomous Region, China

Online:2017-12-18 Published:2018-01-02
Contact: Xu Gui-cun, Master, Chief physician, Department of Emergency Surgery, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010110, Inner Mongolia Autonomous Region, China Li Xiao-he, M.D., Professor, Department of Anatomy, School of Basic Medicine, Inner Mongolia Medical University, Hohhot 010110, Inner Mongolia Autonomous Region, China
About author:Wang Hai-yan, Master, Associate professor, Master’s supervisor, Department of Anatomy, School of Basic Medicine, Inner Mongolia Medical University, Hohhot 010110, Inner Mongolia Autonomous Region, China
Supported by:
the Overseas Science and Technology Project of Inner Mongolia Autonomous Region in 2016; the Science and Technology Project of Inner Mongolia Autonomous Region in 2016

摘要/Abstract

摘要：

文章快速阅读：

文题释义：

有限元分析：有限元分析技术是在工程学和数学材料物理学的广泛应用的方法之一，其重要的应用是对研究对象感兴趣部位的应力应变分析，进行有限元分析的关键步骤是对不同部位，不同组成结构边界值的测定。

锁定钢板：是骨科骨性内植物中常采用的内固定方式，其特点是固定螺钉在固定骨折部位后其末端与钢板接触部位螺纹锁定，从而使螺钉和钢板锁定，提高螺钉钢板固定的稳定性，减少螺钉松动，将螺钉尾部的应力传导到钢板，从而是应力分解，降低螺钉尾部应力过度集中。

摘要

背景：胫骨后方解剖钢板对于胫骨远端复杂骨折具有较好的固定效果，但固定后也存在断钉断板的情况，其具体规律如何尚未有相关研究。

目的：建立胫骨远端锁定钢板固定有限元模型并进行有限元分析，为其设计改造提供参考。

方法：将34岁68 kg男性患者左侧胫骨远端影像学数据导入Mimics16.01软件，利用软件的自动识别和修改功能修饰后进行三维重建，将三维模型导入Ansys11.0软件，再利用solidwork 2014参照解剖测量数据建立锁定钢板及螺钉模型并导入Ansys11.0软件进行配准，并进行面网格和体网格划分，再在胫骨上端垂直加载340 N的力，分析钢板和螺钉的应力分布。

结果与结论：锁定钢板钉孔与螺钉之间连接紧密，钢板的应变大小取决于应力的大小，胫骨后路远端锁定钢板能有效的分解骨折断端应力，应力分布较为均匀，各种运动状态下应力集中部分应力均小于钢板的屈服强度。说明胫骨远端锁定解剖固定钢板应力分布均匀，固定稳定，不易出现断裂。

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
orcid: 0000-0001-7118-9988(Xu Gui-cun)

关键词: 骨科植入物, 骨植入物, 胫骨远端, 锁定钢板, 螺钉, 有限元分析, 应力分布, 疲劳断裂, 生物力学分析

Abstract:

BACKGROUND: The posterior anatomical locking plate has obtained excellent fixing performance in the treatment of complex fractures of the distal tibia; however, there are many drawbacks such as nail and plate broken, and the related rules are never reported.

OBJECTIVE: To establish a finite element model of posterior anatomical locking plate for distal tibia and to provide references for its design and improvement.

METHODS: The imaging data of a male patient aged 34 years old (body mass: 68 kg) with fracture on the left distal tibia were imported into Mimics16.01 software, and the proposed reconstruction parts were determined based on the default threshold of the software. The files were imported into the Ansys11.0 software, the distal tibial surface was fixed, and a force of 340 N was vertically loaded on the supine surface of the horizontal section of the large tibial shaft.

RESULTS AND CONCLUSION: There was completely connected with the stepped surface of nut and screw thread portion in locking steel plate. The strain on the plate depended on the stress values. The posterior anatomical locking plate for distal tibia was more favorable for the fixation at the fracture site and could reduce the fixed plate and screws loosening, both of which could affect the fixed efficacy.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Tibia, Finite Element Analysis, Tissue Engineering

中图分类号:

R318

王海燕，许贵存，蔡永强，李志军，张少杰，高尚，王星，李筱贺. 胫骨远端骨折解剖锁定钢板固定的有限元分析[J]. 中国组织工程研究, 2017, 21(35): 5691-5696.

Wang Hai-yan, Xu Gui-cun, Cai Yong-qiang, Li Zhi-jun, Zhang Shao-jie, Gao Shang, Wang Xing, Li Xiao-he. Finite element analysis of posterior anatomical locking plate for distal tibia[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(35): 5691-5696.

图/表（结果） 5

参考文献

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引言

材料方法

Design

Finite element analysis.

Time and setting

This study was conducted from June to September 2016, at the Digital Medical Research Center of Inner Mongolia Medical University, China.

Subjects

One patient (male, 34 years old, and body mass: 68 kg) with fracture on the left distal tibia was enrolled in this study. This study was approved by the Ethics Committee of Inner Mongolia Medical University (No. 20160823), and the written consent was obtained from the patient prior to the study.

Materials

The posterior tibial anatomical locking internal plant system (422.340 7 holes, right, 80 mm) produced by Double Engine Medical Material Co., Ltd. was used (Figure 1A).

Methods

The finite element model establishment of distal tibia locking plate and screw

Parametric modeling of the posterior tibial anatomical locking internal plant system was performed by the Pro/Engineer3.0 mechanical modeling software (Parametric Technology Corp., Shanghai, China) and the files were output and stored in IGES format (Figure 1B).

The CT scan data were imported into the Mimics16.01 software (Materialise, Shanghai, China), and the proposed reconstruction parts were determined based on the default threshold of the software. The fixation system for the posterior tibial anatomical locking plate was established on Pro/Engineer3.0 and the reconstructed distal tibial fracture model was imported into Mimics16.01. True-up was performed in the software based on the locking plate fixation principle; self-tapping locking screws were installed into all the screw holes in group A, and then the trued-up system was divided by surface mesh and body mesh, exported and saved in STL format. The true-up and fixation were performed for non-locking plate in group B; the files were imported into the Ansys11.0 software (ANSYS Inc., Canonsburg, PA, USA) to establish a finite element model and simulate the stress distribution of the fixation system in a normal human body in the standing position. The distal tibial surface was fixed, and a force of 340 N was vertically loaded on the supine surface of the horizontal section of the large tibial shaft. The stress distribution in the screw holes and screw tails in the steel plate was analyzed.

Configuration of the computer hardware: Asus A43EI243SV-SL laptop (CPU: Intel core i52430M, CPU frequency: 2.4 GHz, memory: 2 GB, DDR3, 1 333 MHz, Windows XP operating system).

Software: Mimics16.01 (Materialise, Shanghai, China), Geomagic Studio v9.0 (Parametric Technology Crop., Shanghai, China); Pro/Engineer3.0 (Parametric Technology Corp., Shanghai, China), Ansys11.0 (Ansys Inc., Canonsburg, PA, USA).

Establishment of distal tibial fracture model

The CT scan data were imported into the Mimics16.01 to reconstruct the structure by setting the threshold. Images of different structures were realized by different masks, and the noise and redundant structures were erased through planar editing and stereoscopic editing. Finally, each mask was reconstructed by three-dimensional calculation to clearly visualize the model of distal tibial fracture. The files were saved in IGE format and modified in the reverse engineering software Geomagic Studio v9.0 by manual and automatic methods to repair the damaged surface and body, thus ensuring that the boundary of the reconstructed structure was smooth, clear and real (Figure 2).

The establishment of finite element models of posterior anatomical locking plate for distal tibia

The three-dimensional model of distal tibial fracture was imported into Mimics16.01, and the established locking plate and screw fixation system was imported using the MedCAD of Mimics16.01; then the three parts were trued up using the true-up module of the software (Figure 3). The imported Ansys surface mesh files in the LIS format were transformed into body mesh files using Ansys11.0, and were then imported into the Mimics16.01 for material distribution. The Heinz gray value of each unit of the body mesh was calculated based on the scanning image data using the FEA function of Mimics16.01, and then the corresponding materials were defined respectively, according to different gray scale range. The finite element model (Figure 1) of each material was established based on its assignment (referring to previous literatures^[5-6], Table 1).

Loading and calculation

(1) The lower surface of distal tibia model was fixed, and a load of 340 N was applied continuously and on the upper surface of the tibia, and evenly distributed on each node of the surface. There were two types of load: static vertical load, a load of 340 N applied on the upper surface of tibia; and rotating loading, a load of 340 N applied on the upper surface of tibia with 3 N•m torque.

Stress and strain measurement

The stress and strain were expressed by qualitative and quantitative methods. The former was represented by distribution cloud figure, and the latter was calculated as follows: (1) The mean VonMises stress and deformation of different sections of the steel plate and screws were calculated (stresses of 15 point at each section level of the steel plate was measured; the screw was divided into three sections, and stresses of 15 evenly distributed point were measured on the cylindrical surface) (Figure 3).

Main outcome measures

The stress values on different parts of the posterior anatomical locking plate were measured by Ansys software. The stress and stain values at different positions were measured.

Statistical analysis

SPSS11.0 software (SPSS Inc., Chicago, IL, USA) was used for statistical analysis, and the data are expressed as mean±SD. Paired t test was used to compare the stresses of steel plate and screw hole circumference, and three sections of the screw were analyzed by repeated measures variance.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

讨论

Locking anatomical steel plate is commonly used in high energy injuries in the distal tibia because it overcomes many disadvantages of traditional anatomical steel plates, including broad soft tissue dissection, postoperative adhesions, joint ankylosis or flexion limitation. Currently, the commonly used locking plates are screw locking plates^[20-26].

The locked fixation system cause no additional pressure on the bone surface and can effectively protect the blood circulation in the fixed section of the bone. Besides, the locking screw and the steel plate are integrated together and provide a better angulation stability for the broken ends of fractured bone. The distal inner implant and the distal tibia are closely fitted and more suitable for osteoporosis patients, and furthermore, the patients can exercise their knee joints in early period to avoid knee enstrophe and ecstrophy^[27-29].

Although the posterior anatomical locking plate fixation device for distal tibia has been extensively used, there are many clinical reports on screw loosening and plate and screw broken^[30-33]. Thus we tried to analyze the commonly used fixation operation methods by finite element analysis to compare the stress on different sections of the plate, the screw hole edge and the screws in each fixation mode, so as to provide a mathematical physics model for the improvement of the fixation device. We successfully performed mesh division of the posterior anatomical locking plate for distal tibia using Mimics13.0, Geomagic Studiov9.0, Pro/Engineer3.0 and Ansys11.0 based on the screw track data measured in section 2 and screw insertion principle. The established finite element model showed good morphological similarity with the real structure, the bone materials were assigned completely according to the gray values from the CT scan, and the fixed internal implants were assigned according to the labeling materials in manufacturer’s manual. Thus the whole model resembled the real one and could simulate the actual stress in the patients at the upright position. In current study, since there was no contact between the outer circle cylinder of the bolt and the corresponding screw hole on the fixing plate, and the fixing plate was merely connected with the stepped surface of nut and screw thread portion in the non-locking steel plate, the deformation of the fixing plate was significant due to the great contact stress on the small contact area. Since the outer circle cylinder of the bolt was totally contacted with the corresponding screw hole on the fixing plate, and the fixing plate was also completely connected with the stepped surface of nut and screw thread portion in locking steel plate, the deformation of the fixing plate was not obvious due to the little contact stress on the large contact area. Based on the data from the simulation analysis on the locking and non-locking plates, the stress and deformation of the locking plate were only about half the non-locking plate, indicating that it is unlikely that the locking plate becomes loose in clinical application. Therefore, the posterior anatomical locking plate for distal tibia was more favorable for the fixation at the fracture site and could reduce the fixed plate and screws loosening, both of which could affect the fixed efficacy and result in more surgery.

The stress of each part of the posterior anatomical locking plate fixation system for distal tibia was smaller than the yield strength of the titanium alloy screw, 894-1 034 MPa^{[13, 34-38]} in all the fixed and moving states; therefore, there was no plastic deformation or fracture in the fixation system.

The imaging data of male youth with normal bone mineral density and bone tissue strength were used for modeling, and the finite element model stress analysis was only applied in one sample, thus lacking universality. The finite element analysis and in vitro validation test should be performed in more samples in the future to obtain data with universality to guide clinical application; bone loss and osteoporosis are induced by decline in estrogen level in the aged people, especially the elderly women; thus the effective pullout strength between the vertebra and vertebral nail is reduced^[39-41] in such population, and the stress in the fixation system is different from that in the experimental model. Therefore, more studies should be carried out in patients with osteoporosis and other kinds of distal tibial fractures.

In summary, the posterior anatomical locking plate for distal tibia is more favorable for the fixation at the fracture site and can reduce the fixed plate and screws loosening, both of which can affect the fixed efficacy. Furthermore, all the fixed and moving states exhibit no plastic deformation or fracture in the fixation system.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

胫骨远端骨折解剖锁定钢板固定的有限元分析

Finite element analysis of posterior anatomical locking plate for distal tibia

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